Prostate Flashcards
LUTS symptoms / IPSS questionnaire = international prostate symptom score
Incomplete emptying Frequency intermittency Urgency Weak stream Straining Nocturia
LUTS - more likely to be BPH or cancer?
BPH affects urethra more quickly than cancer
Voiding vs storage problems
Voiding = Hesitancy Weak stream Intermittency Incomplete emptying
Storage symptoms:
Frequency
Urgency
Nocturia
What might cause voiding symptoms?
BPH Urethral stricture (in young men)
What might cause storage symptoms?
Detrusor overactivity
Investigations
Frequency volume chart Haematuria DRE Urine flow check Urine dpstick Flow rate Bladder scan u and e psa renal USS Cystoscopy to check for strictures
What objects are used to estimate sizes of the prostate?
Ping pong ball size
Tennis ball
What conservative and medical management
Conervative - reassure and advice on fluid intake
Medical:
Alpha blockers - tamsulosin, alfuzosin
5 alpha reductase inhibitors - finasteride, dutasteride
Herbal meds for BPH
Saw palmetto
Surgical management for BPH
TURP - trans urethral resection of prostate
Other options for managing BPH
Laser surgery
Rezum/steam
urolift - stapling lobes of prostate to side
Embolisation (for elderly if not fit for spinal anaesthetic)
Long term catheter
5 alpha reductase inhibitors
Finasteride, dutasteride
Alpha blockers
Tamsulosin, alfuzosin
Treatment of overactive bladder - conservative
Reassure
Bladder training exercises (BAUS)
Dietary advice
Treatment of medical management for overactive bladder
Anticholinergics
Beta agonist
Anticholinergics used for overactive bladder
Oxybutinin
Tolterodine
Solifenacin
Beta agonist used for overactive bladder
Betmiga
Surgical management of used for overactive bladder
Botox to knock out detrusor
But wears off after 6 month
Risk factor for prostate cancer
Afrocarribean males
BRCA2 genes
A PSA over what range gets investigated
Anyone with a PSA over 3
Causes of raised PSA
BPH Urinary retention Infection Catheter Prostate cancer
What investigation does not cause a raised PSA
DRE
What is used to GRADE the prostate cancer? What indicates low risk? What indicates high risk?
Gleason scoring system
3 + 3 low risk
5 + 5 high risk
Investigations for prostate cancer
grading
Staging
MRI / bone scan
MDT discussion
Active surveillance is used for which patients with prostate cancer?
For young men
When would you do watchful waiting for prostate cancer? What do you do afterwards?
Elderly
Co-morbid patients
Delay hormonal treatment which cuts off testosterone until it is absolutely needed (as it you get menopausal treat
Main SE of prostate cancer therapy
Erectile difficulties
Incontinence
Radical radiotherapy is used for which patients with prostate cancer?
Higher PSAs
Older patients
Which of these treatments doesn’t actually cure patients?
Hormones and chemo doesn’t cure patients
Types of hormonal therapy for prostate cancer
Antiandrogen - blocks testosterone receptors directly
LHRH agonist - overstimulate pituitary
Why are antiandrogens started before the LHRH agonists?
Over production of testosterone initially due to LHRH agonistic activity
Causes rapid fall of testosterone
Wh
Why are antiandrogens started before the LHRH agonists?
Over production of testosterone initially due to LHRH agonistic activity
So if someone has spinal mets, can make it worse
So give antiandrogens first
